“hypertension, hypercholesterolemia, and blood glucose are associated with both unilateral and bilateral knee OA independent of obesity, and support the concept that OA has an important systemic and metabolic component in its etiology”

This shows that osteoarthritis is not just a wear and tear pathology. Systemic and metabolic factors have a huge influence.

The take home clinically…lifestyle factors in OA patients need to be addressed for the best outcomes.

On March 3rd, 2018 we welcomed our first child into the world. Remi Hendrix Rogers Swanson was born at 11:06pm in Asheville, NC.

As many parents say, words can’t describe this experience. The amount of love and joy of having a baby are so overwhelming that the mere act of trying to put it into words diminishes its significance.

It’s been 1 week since he was born. It feels as if we’ve been time traveling. Looking back, there’s a few things we’ve learned in the first week.

7 Things We Learned in One Week

1) MY WIFE IS SUPER HUMAN

When it comes to birth, most people discuss the baby and parenting. One thing I wasn’t prepared for was the intensity and the thrill of the birthing process. While there are many digressions I could go into, I think the most amazing aspect was watching my wife, Gaelyn, act like a superhero.

I’ve always thought the most of Gaelyn. She’s an incredible person, extremely strong, and has never shied away from adversity. But after watching what she did during the weekend Remi was born, I have a new role model myself.

She never wavered, didn’t resist, embraced the intense struggle, and went above and beyond the insane requests her body and Remi were making. Hell, she even made a few jokes in-between the intense contractions. Her rockstar performance made me feel honored to be her husband. I’ve never been so proud in my life.

Watching birth also solidified the notion that women are the stronger gender. We’re lucky they keep us around.

“When nothing is certain anything is possible”

-Many Hale

Now of course we don’t want to hear this answer to certain simple questions.

We don’t want the local to tell us “I don’t know” when we’re lost and asking for directions. We don’t want our financial advisor to say “I don’t know” when we ask him if our investments are doing well. We don’t want our physical therapist to say “I don’t know” when you ask him why breathing is important.

There’s definitely a time and a place for the “I know” answer.

But maybe for some questions we should look for the “I don’t know” answer.

Ephemerality

1) “There are many forms of ephemeral art, from sculpture to performance, but the term is usually used to describe a work of art that only occurs once, like a happening, and cannot be embodied in any lasting object to be shown in a museum or gallery.”

2) “Because different people may value the passage of time differently, “the concept of ephemerality is a relative one”.[3]

3) One of the things I like most about hiking is the ephemerality of it. Depending on the time of day, the weather, the season, the animals, and the people, it’s different every time. It is constantly altered by time and perspective. And on a bigger scale, with the soaring trees, wrapping vines, flowing rivers, and tectonic shifts, the natural world could be considered the greatest ephemeral “art”.Continue reading “2017 Hits : Vol. 1 : Ephemerality”

Other Good Stuff

1. More bad news for our phone addicted society. Using your phone at night decreases your alertness the next day.

2. You should watch the documentary, Minimalism, on Netflix. You don’t have to start throwing away stuff, but you might want to utilize their concepts: true values, needs vs. what we can afford, seeing through capitalism’s traps/brainwashing, and spending time where it matters. It’s definitely worth the watch.

3. “As a maker, you tend to do too much, because you’re there with all the tools and you keep putting things in. As a listener, you’re happy with quite a lot less.” –Brian Eno

4. This 10 second video explains why our country is having so many problems.

5. Singularity, when artificial intelligence escalates to a point of runaway technological growth and change the word, is a very interesting concept. Maybe it’s what needs to happen to save our species and our planet?

6. Look into your dog’s eyes. It will release oxytocin and make you both feel better.

Intermittent Fasting / Time-Restricted Eating

Definition: intermittent fasting or time-restricted eating is an umbrella term for diets that cycle between periods of fasting (no eating) and periods of non-fasting (eating)

I’ve been experimenting with intermittent fasting for several months now.

I first heard about it when I was in grad school. One of my clinical instructors quoted a study that showed the only proven way to prolong life was through fasting.

Recently, I’ve been seeing more and more studies, blogs, and people talking about intermittent fasting. My friends Seth Oberst and Jeff Ford have both told me about the profound benefits of this “diet”. So like all health interventions, I thought I’d take a look at the best study out there…an experiment on myself.

At first I was skipping breakfast and only eating from 12pm-8pm.

This was terrible. It really threw my system off. I didn’t feel great. I didn’t have any energy. And I gained weight.

But I was responsible for a big part of this failure. By the time I got home from work around 5:30 I was starving. I started eating a ton of pre-dinner snacks as I was cooking dinner. Then I’d over serve myself for dinner and finish it. I was essentially eating most of my calories between 5-8pm.

Then I read some studies on the circadian cycle and how important it is when it comes to diet and weight loss (future post on this in Vol. 2). So I started trying to simply cut down the hours of eating per day. I started to trim the hours back from the latest meal. I tried to make my last meal earlier in the day.

An 8 hour cycle isn’t socially possible as a physical therapist. I can’t eat my breakfast eggs while working on someone’s shoulder. Well, maybe if it was a breakfast burrito, but that wouldn’t be good for business.

So instead I try to eat my last meal before 7pm. It usually ends up being a 10-11 hour feeding time. I also try to prepare a shake a couple times a week and skip dinner to cut the feeding time down even more.

With this type of early time-restricted feeding I’ve had a lot more success. It allows me to reap the benefits without sacrificing my social life or developing orthorexia nervosa. I feel better, have lost some weight, and have more energy.

And another important benefit…it makes day-drinking much more acceptable!

The last benefit is worth pondering. By using time-restricted feeding as the global focus, it allows for individual variability in the details. In other words, it doesn’t limit specific foods or cause a purge from prolonged suppression. It allows people to use whatever diet works for them (paleo, vegetarian, ketogenic, etc.) in a more efficient manner.

“Thinking of obesity as an energy-balance disorder is as meaningless as calling poverty a money-balance problem”

“obesity is not an energy-balance disorder but a disorder of excess fat accumulation and so, clearly, a hormonal and metabolic disorder – the result of an ‘endocrine disturbance’, as it was phrased in the 1930s by Eugene Du Bois, then the leading American authority on metabolism. By this logic, the foods we eat influence fat accumulation not because of their caloric content but because of their macronutrient content, the proteins, fats and carbohydrates they contain. This paradigm attends to how organisms (humans, of course, in particular) orchestrate the careful ‘partitioning’ of the macronutrient fuels they consume, determining whether they will be burned for energy or stored or used to rebuild tissues and organs.”

“By this way of thinking, refined sugars are indeed toxic, albeit over the course of years or decades. We get fat and diabetic not because we eat too much of them – although that is implied tautologically merely by the terms ‘overconsumption’ and ‘overeating’ – but because they have unique physiological, metabolic and hormonal effects that directly trigger these disorders”

“Bauer argued that fat cells are clearly being driven by these factors to hoard excessive calories as fat, and this in turn would deprive the rest of the body of the energy it needed to thrive. In this hormonal/regulatory conception, excessive fat-accumulation causes hunger and physical inactivity, not the other way around.”

“if insulin is a fat-forming hormone and Type 2 diabetes is a disorder of insulin resistance, it then follows that high circulating levels of insulin in the blood, rather than insulin deficiency, could be the cause of the disease and obesity as well.”

“Perhaps the obese get that way not because they eat too much or exercise too little, but because they have elevated levels of insulin or their fat tissue is excessively sensitive to the insulin they secrete”

“The sugars and refined grains that make up such a high proportion of the foods we consume in modern Westernised diets trigger the dysregulation of a homeostatic system that has evolved to depend on insulin to regulate both fat accumulation and blood sugar. Hence, the same dietary factors – sugars and refined grains – trigger both obesity and diabetes. By focusing on the problems of eating too much and exercising too little, public health authorities have simply failed to target the correct causes.”

11) Obesity is one thing. Diabetes is another. The sugar epidemic is going to cause ALOT of problems in the future. Not only for our health, but also for our economics.

The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.

If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

Social & Communication

1. Social interaction is an important aspect of health. Specifically, the people you are around the most influence your decisions more than any health practitioner can in one visit. Researchers are starting to wonder if this social support is an easy change that healthcare is not taking advantage of. Here in this article they introduce a 5 step ladder to social support.

“An optimistic outlook, positive coping strategies, and strong external social support are common characteristics found in individuals who returned to sport after hip arthroscopy for femoroacetabular impingement.”

3. Nature AND Nurture.

“When preschoolers spend time around one another, they tend to take on each others’ personalities, indicates a new study by Michigan State University psychology researchers.”

Training / Strength & Conditioning

“Give people what they want and they will like you for now. Give people what the need and they will value you forever.” -Simon Sinek

1. This is a phenomenal response to those who say exercise doesn’t help you lose weight. So much good stuff in this article.

“To sum up, training and diet work synergistically. You need both, and stalls in weight loss can often be countered by doing whichever one you aren’t.”

2. “We should contraindicate people from exercises, not exercises from people” -Eric Cressey shared a valuable post on individualized exercise prescription and the variables that matter.

3. If this was in pill form everyone would take it.

“Elderly women who sit for more than 10 hours a day with low physical activity have cells that are biologically older than their chronological age by eight years compared to women who are less sedentary, research shows.”

Pain

1) Greg Lehman is giving away his latest pain science workbook, Recovery Strategies. It’s a very indepth source on pain with a self-assessment at the end.

2) Which bias do you want to confirm? Derek Griffin thinks we should use this research to support SiMs not DiMs. Support your patients beliefs that they’ll get better. “Humans update self-relevant beliefs to a greater extent in response to good news than bad news.”

4) Pain science education is much more than what the practitioner knows. The key component is communication. Especially being able to read people and perceive how they’re reacting to what you’re saying. Very similar to how a comedian develops their jokes.

2) What’s the difference between a physiological response to a stimulus and a conscious emotional reaction? Are we really angry, or are we just labeling an unconscious physiological process that we can’t consciously understand? There’s research out there that supports this train of thought.

Psychology, Mental Health, Mind Training

“Empathy depends on your ability to overcome your own perspective, appreciate someone else’s, and step into their shoes. Self-control is essentially the same skill, except that those other shoes belong to your future self—a removed and hypothetical entity who might as well be a different person. So think of self-control as a kind of temporal selflessness. It’s Present You taking a hit to help out Future You.”

General Healthcare

1) It’s complex. It’s more than insurance coverage. It’s more than lifestyle. It’s about the lack of equality. It’s about the lack of opportunities for certain groups. It’s about people not having the things that many of us take advantage of everyday. One study shows that “alow socioeconomic status is so damaging to health, it reduces life expectancy by 2.1 years.” In some areas I’m sure this number is much higher. #values #compassion #helpthoseinneed

The Knowbodies Interview, Asheville Beer, & The Guitarist Analogy

1) The Knowbodies are three physical therapist that have created a podcast to help create healthier and more informed society. They cover a great breadth of topics, from equine therapy to dentistry to sleep. And now they have a rambling PT that can’t pronounce his -ings.

I recently did an interview with them on how I manage and appraise information. It was great experience. They asked great questions and were a pleasure to talk to. It was also interesting to hear the different questions each of them had. They all have their own style and approach towards interviewing. This allows the listeners to gain all these perspectives in one listen.

2) I wrote an accompanying blog post on dealing with information overload. Part 1 goes over some of the problems. Part 2 gives 6 tips on how to better manage and appraise information. I think these articles can be valuable for anyone that wants to improve their information digestion. Here’s the quick tl/dr summary:

Wim Hof

1) Wim Hof, aka “The Iceman”, is a very prominent and influential figure who has been an advocate of using focused breathing techniques and cryotherapy to change…well, everything if you ask him. His methods have been around for a while now and many have had very positive results utilizing his principles. Here are some articles and information on Wim Hof.

2007: He climbed to 6.7 kilometres (22,000 ft) altitude at Mount Everest wearing nothing but shorts and shoes, but failed to reach the summit due to a recurring foot injury.

2009: In February Hof reached the top of Mount Kilimanjaro in his shorts within two days.Hof completed a full marathon (42.195 kilometres (26.219 mi)), above the arctic circle in Finland, in temperatures close to −20 °C (−4 °F). Dressed in nothing but shorts, Hof finished in 5 hours and 25 minutes.

2011: Hof broke the ice endurance record twice, in Inzell in February and in New York City in November. The Guinness World Record is now set for 1 hour and 52 minutes and 42 seconds by Hof. In September, Hof also ran a full marathon in the Namib Desert without water. The run was performed under the supervision of Dr. Thijs Eijsvogels.

3) Here’s one of his famous studies where he was injected with toxins and was able to control his autonomic immune response.

“Hitherto, both the autonomic nervous system and innate immune system were regarded as systems that cannot be voluntarily influenced. The present study demonstrates that, through practicing techniques learned in a short-term training program, the sympathetic nervous system and immune system can indeed be voluntarily influenced. Healthy volunteers practicing the learned techniques exhibited profound increases in the release of epinephrine, which in turn led to increased production of anti-inflammatory mediators and subsequent dampening of the proinflammatory cytokine response elicited by intravenous administration of bacterial endotoxin. This study could have important implications for the treatment of a variety of conditions associated with excessive or persistent inflammation, especially autoimmune diseases in which therapies that antagonize proinflammatory cytokines have shown great benefit.”Continue reading “2017 Hits : Vol. 1 : Clinical – Wim Hof & Cryotherapy”

Movement Meditations

“We get resourcefulness from having many resources. Not from having one very smart one.” -Marvin Minsky

Meditation can scare people. I think it’s because most people don’t really know what it is. They think it’s a medium that turns people into monks. Or they think it’s simply the act of having no thoughts. These two ideas couldn’t be further from the truth (no pun intended).

In broad terms, meditation is the practice of quieting the mind and improving awareness.

In the realm of health and quality of life, meditation can lead to improved working memory, less emotional reactivity, decrease biases, increased focus, relationship satisfaction, enhanced self-insight, and improved brain function (among other things).

Shock Absorption & Eccentric Control

1) Being able to attenuate force efficiently is extremely important. A loss in variability or efficiency in shock absorption can cause the forces to be absorbed in a maladaptive manner. #ConservationOfEnergy

Lower Extremity

Hip

2) Some great clinical insight on chronic hip flexor strains from Dave Tilly. I love the idea of treating the hip like the shoulder in regards to PNF rhythmic stabilization and wall ball circles.

3) The hip and the back are always related. “The authors concluded that dynamic pelvic orientation significantly influences the functional orientation of the acetabulum. This study also found that people with impingement have reduced trunk control bilaterally, supporting the need to include trunk rehabilitation in treatment. This has implications for therapists rehabilitating patients with symptomatic FAI as not only should the trunk be a strong focus of rehabilitation but pelvic positioning during exercise and ADLS can have an impact on the positioning of the hip and range of movement.”Continue reading “2017 Hits : Vol. 1 : Clinical Lower Extremity”

Upper Extremity

Shoulder

1) Too many people advance too quickly with pull up progressions. Too few spend enough time mastering the hang. Dan Pope writes a nice concise post with 3 basic hang exercises for the shoulders. And he backs it up with some solid biomechanical logic.

2) Eric Cressey gives a nice 3 minute breakdown of proper cueing for the scaption exercise. I think a tactile cue for posterior tilting the scapula is one of the best rehab interventions out there.

3) Heart disease and rotator cuff symptoms are linked in a new study. Maybe it has to do with circulation? Or maybe the rotator cuff symptoms are just the output of a lifestyle dysfunction?

Spine

“Usually, the best exercise is the one that creates the largest effect with the minimal risks” -Stuart McGill

Cervical

1. It’s more than a chin-tuck and lift. “Elder women with cervicogenic headache had significantly reduced rCSAs of the rectus capitis posterior major and multifidus muscles compared to controls (p < 0.05). Larger amounts of fat infiltrates were also observed in the rectus capitis posterior major and minor and splenius capitis muscles in the cervicogenic headache group (p < 0.05). There were no changes in the size and fat infiltrate in the cervical flexor muscles (p > 0.05).”

2. This is a solid collection of exercises from the Prehab Guys for cervicogenic patients. I really like the cueing in the quadruped deep neck flexor exercise.

Thoracic

4. I had a patient who complained of bilateral hand numbness when she was washing her hair. The MD diagnosed her with bilateral carpal tunnel syndrome. She got better with treatment directed at her thoracic spine, shoulders, and neurodynamics. Moral of the story: the patient will give you the answer in the history and if something is bilateral you should probably look proximal.

Lumbar

5. The veins leaving the vertebral bodies are the only veins in the body that lack valves. They may act as hydraulic shock dampeners. Which is another reason why a healthy cardiovascular system is such an important variable in low back patients.

6. I see this all the time in the clinic. The hip and the back are always related. A recent study on LBP patients gives us research ammo for our empirical evidence, “On physical examination, 81 (80%) had reduced hip flexion; 76 (75%) had reduced hip internal rotation; and 25 (25%) had 1, 32 (32%) had 2, and 23 (23%) had 3 positive provocative hip tests.”

7. If you have a patient that is flexion intolerant, but can’t tolerate the traditional prone press-up, try this quadruped transition (learned from Erson). I find it much less compressive.

Miscellaneous

“The patient’s nervous system can sense both a lack of practitioner confidence, as well as a lack of control.” -Dr. Andrei Spina (via Shante)

1. “Evidence has shown that performance and variability have an inverse curve relation (too little variability, performance suffers and with too much variability, performance also suffers). Current evidence shows that an optimum balance of variability seems to be the key to maximize performance of an individual and achieving this balance is key in recovery.” –Adriaan Louw

This is a collection of information to help improve health and movement. It includes articles, videos, and quotes that I have found helpful in studying the human species. Due to the complexity of this subject matter, I have tried to include a variety of variables that can influence the dynamic system.Continue reading “2017 Hits : Volume 1 : Table of Contents”

1) I heard this quote from Tim Ferris’s weekly update. Something I definitely need to embrace. ““Reading, after a certain age, diverts the mind too much from its creative pursuits. Any man who reads too much and uses his own brain too little falls into lazy habits of thinking.” – Albert Einstein

2) James Cameron was right. The trees are connected through an underground web. They do talk to each other. Here’s a great TED talk explaining this complex system.

3) “Lack of sleep can negatively affect memory, emotional processing and attentional capacities. For example, sleep deprivation has been shown to disrupt functional connectivity in hippocampal circuits (important for memory), and between the amygdala (important for emotion regulation) and executive control regions (involved in processes such as attention, planning, reasoning and cognitive flexibility).“

4) Turn your phone screen black and white to break the addiction. “Emotions and attention are tied to color perception, so what if everyone removed the color from their phones? “

5) Keep earning your title. A great read from Derek Sivers. This is why I’m skeptical of taking advice from “clinicians” that don’t have a current practice.

1) Repetition = Persuasion. One of the benefits of a checklist assessment type of examination is that it is repeatable and consistent. This not only makes it clinically effective, but it makes it repeatable and consistent. So instead of chasing a different pain path every time the patient comes in, you repeat the assessment, repeat the clinical reasoning, and repeat the treatment approach. Instead of confirming their hypochondriac wonders by chasing pain, persuade them with repetition and consistency. So stay consistent and keep repeating yourself (more than just words). Repetition = Persuasion.

2) Create the “curiosity gap”. “Our results suggest that using interventions based on curiosity gaps has the potential to increase participation in desired behaviors for which people often lack motivation,”

I recently listened to Brene Brown’s The Power of Vulnerability. I was hesitant at first. It seemed like a self-help book about the latest pop-psychology trend. Plus, I had watched the TED talk and thought it was suffice for the subject.

“Nothing is either good nor bad but thinking makes it so.” -Shakespeare

Psychology, Mental Health, Mind Training

1) Buy a djembe and drum up some good vibes.. “When viewed holistically, communal drumming creates a physical and emotional experience of belonging that addresses one of the core psychological components of depression: feelings of isolation, alienation, invisibility and worthlessness.”

2) “What people are paying attention to doesn’t just reveal who they are… it makes them who they are in that moment”’ –Robert Cialdini

3) Your narrative identity is important. Is your life a contamination story? Or a redemption story?

4) Dropping forms. “Well, consistency is good, right? Only to the degree that we want to be who we have been.”

5) A different kind of medication – “A single dose of psilocybin, the active ingredient of magic mushrooms, can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show.”

6) Sleep and the circadian cycle continues to show its importance in research. This latest research shows how disrupting the circadian cycle can lead to “helplessness, behavioral despair, and anxiety-like behavior”

7) Looking at trees decreases your stress more than looking at buildings #GetOutside

8) Want to soothe your cognitive dissonance (both conscious and unconscious)? Put on some music. “Thus, because we constantly grapple with cognitive dissonances, we created music, in part, to help us tolerate – and overcome – them.”

12) The body-mind connection is real. Here’s a classic study to support it “In study 1, participants who briefly held a cup of hot (versus iced) coffee judged a target person as having a “warmer” personality (generous, caring); in study 2, participants holding a hot (versus cold) therapeutic pad were more likely to choose a gift for a friend instead of for themselves.”

14) People are apart of your enviornment too. “Partners of people with depression are more likely to suffer from chronic pain, research has found.”

15) “Most of the bad feelings you have are caused by irrational beliefs. Next time you’re feeling negative emotions, don’t focus on the event that you think “caused” them. Ask yourself what belief you hold about that event. And then ask yourself if it’s rational”

“uses social facilitation to foster an environment of continuous improvement and accountability to the team”

18) Writing your story is good for your mental health – “Professor James Pennebaker has shown that just 20 minutes of writing your story for 4 days has the power to dramatically improve your life. It helps people overcome anxiety, tragedy and heartache. Those who wrote about their problems felt happier, slept better, and even got better grades.”

Neuroscience

19) Cortical representation is interesting. These researchers are asking better questions: “That we found no relationship between S1 representation and the duration of CRPS signs and symptoms is intriguing and raises some novel possibilities: is the difference in S1 representation between hemispheres pre-morbid and does it reflect a vulnerability to CRPS onset? Or might the difference between hemispheres arise early on in the disease, for instance soon after injury or during immobilisation?”

20) Now we can tell our significant others that it’s for an altered state of consciousness -“rhythmic sexual stimulation – if intense enough and if it lasts long enough – can boost neural oscillations at correlating frequencies, a process called “neural entrainment.”

Pain

21) This is some good shit. “Swearing can add emotion and colour to a description, salience to a statement or be used as a means of acceptance – the willingness to break a cultural taboo in front of others creates an atmosphere of informality and a sense of community. Swearing can also act as a cathartic means to cope with pain.”

25) This is one of the better pain articles I’ve read in awhile – “It is important to clarify here that although we talk about the mind, thinking and emotions in relation to pain, the actual experience of pain emerges in the person and is felt in the body or the space in which the body should reside (for many biological reasons). The notion that pain is in the brain or in the head is nonsense. And, we are more than a brain.”

“Furthermore, Dr. Sarno also began to see associations between emotional distress, early life adversity, and certain personality profiles (notably perfectionism and the need to please) and the onset of back pain and other so-called functional syndromes, such as headaches and irritable bowel syndrome. And most importantly, he found that when a patient is diagnosed with having a psychosomatic illness and given a clear understanding of that process, many people have dramatic resolutions of their symptoms, even if they were of a long-standing nature.”…”Over time, a few other physicians and therapists began using Dr. Sarno’s methods and they had equally impressive results. Research studies came out showing that most people with chronic back pain do not have a clearly defined medical explanation and that MRIs are abnormal in the majority of adults who do not have back pain. Studies of surgery for back pain have not shown better results than non-surgical interventions. Injections for back pain have not been shown to be better than placebo injections. Studies of brainimaging show that physical pain and emotional pain are equivalent and that emotionally laden regions of the brain (rather than somatosensory areas) are activated in chronic back pain. And emerging research shows that psychological interventions that target emotionsare showing significant results.”

27) How do you adapt to millions of years of harsh and painful conditions? Evolve the ability to dim sensory perception to modulate pain. “Evolutionary tweaks to the amino acids in their pain receptors make naked mole rats extremely insensitive to pain after they are born.”

28) Sure, diagnoses and biomechanical talk can cause fear. But it can also cause ease, understanding, and social belonging. “These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation.” And remember that loneliness is linked to increased pain…

30) I like using the LANSS questionnaire. I have my patients with signs and symptoms of central sensitization fill it out. It helps them understand that what they’re feeling is normal. It helps them feel that others have these symptoms too. See #28

Opioids

33) Regarding Opioid Induced Hyperalgesia, “Your biology fights back and says, ‘I’m blindfolded to pain by all these chemicals. I need to be able to sense pain again.” -Martin Angst

34) But let’s not throw the baby out with the bathwater…”There is no question that in many cases opioids have been used inappropriately (prescribed too much or too little, given at too high or too low of a dose) for many individuals suffering with pain. But, it is also a very effective drug for many people in pain. Opioids help reduce acute nociception and can potentially reduce the risk of developing chronic pain for those in the more acute phase. They can also be an effective part of a comprehensive chronic pain treatment for some. My hope is that those of us in the physical therapy profession educate ourselves properly and understand how to talk to our patients about the use of opioids, because they will ask us.”-Korzy Zimmer

36) Ask your patients if they take any pain medication. Educate them on how to use medicine after surgeries and injuries. Be a responsible provider.

The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.

If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

1) Environment matters. Want to know more about your patient’s environment? Look at their significant other. “Doctors tend to treat people as individuals, guided by the need to ensure patient confidentiality. But knowing about one partner’s health can provide key clues about the other’s. For instance, signs of muscle weakening or kidney trouble in one may indicate similar problems for the other.”

3) Are we overlooking the blood flow component of tendinopathies? “Tendon blood flow tends to decrease with age and compression, which often results from increased mechanical load. This decreased vascularization, at least theoretically, can contribute to the probability of tissue damage as tissue compliance and flexibility will be compromised (LER). Oxygen consumption of ligaments and tendons is 7.5% lower than skeletal muscle, which may contribute to longer healing times (2,3).”

4) The Gait Guy’s breakdown of a case study is always worth the time. In this one they find the driver in the spine. In this one they breakdown the biomechanics of 4 different runners.

5) What do we use to regulate ourselves? Thought or awareness? Seth teaches us how using thought can lead to chronic pain. “But we can’t think our way out of a physical “problem”. The autobiographical self (story we tell ourselves) and the embodied self (our experience in the present moment) are separate neural networks.“ Continue reading “Fall Hits 2016: Clinical”

This is a collection of information to help improve health and movement. It includes articles, videos, and quotes that I have found helpful in studying the human species. Due to the complexity of this subject matter, I have tried to include a variety of variables that can influence the dynamic system.

In an attempt to avoid information overload, I’ve separated the information into different categories.

I will post each category separately to make it easier to scroll through.

The links below will be added over the next month as they are posted.

Feel free to follow me on social media to keep up to date on the latest postings.

Making this information accessible for everyone takes a great deal of effort and time. If you have the resources, please consider a donation. Your support to maintain this website is greatly appreciated.

“Perception and perspective are often the fundamental difference that control human behavior and the quality of our lives” -Tony Robbins

Psychology, Mental Health, Mind Training

1. “In the midst of the widespread support and criticism of psychoanalysis there has been significant progress in its use as a valid approach to treatment. If for no other reason than to gain an important historical perspective on mental health treatment Freud’s psychoanalytical theory is worthy of study.”

2. Fake it till you make it. “People using self-talk, for example telling yourself “I can do better next time” – performed better than the control group in every portion of the task.”

3.Curiosity – the bias killer. “Neither intelligence nor education can stop you from forming prejudiced opinions – but an inquisitive attitude may help you make wiser judgements.” Maybe we should focus on the questions and creating the curiosity/knowledge gap?

“The sign of a good doctor should be how many patients he can get OFF medications, not how many he puts on.”

1. NYTimes writes a story about surgery being no more, if not less, effective than exercise. Yet still being popular. Interesting that they didn’t interview a physical therapist in this article. You think that might be apart of the problem? #GetPT1st

2. Addiction is a serious problem in our country. Know where to get more information – Addiction Resource & ASAM

3. The slow catastrophe of antibiotics – “At least 23,000 people die as a direct result of antibiotic-resistant infections, and many more die from other conditions that were complicated by an antibiotic-resistant infection, the agency says.”

1. “If we aren’t physically fit, maybe our environments are perceived as more threatening than they really are so we become more rigid and tense in an effort to protect us from too much movement that could be dangerous. It’s a perceived mismatch between us (our self-image) and our environmental demands. The bigger the gap between what we need to do and what we think we need to do, the more tension and threat we will perceive.” -Seth Oberst and Ben House with an article on autonomics

2. “Hypertrophy of the masseter muscle often causes tension type headache. This review concluded that conservative treatment such as counselling, exercises, occlusal splints, massage and manual therapy are the best way to treat TMDs. ”

3. Unless you’re getting paid to play, what’s the rush? “Athletes who wait at least 9 months after an anterior cruciate ligament reconstruction and/or regain quadriceps strength compared with the uninjured limb may be at lower risk for reinjury than those who fail to meet these criteria.”

4. It’s changing the expectations, educating on the long term recovery, and teaching tissue remodeling principles – “Metabolic activity evident six months after an Achilles tendon rupture”

5. If you’ve been reading this blog you know the importance of isometric contractions to reduce pain. Here’s another study supporting this empirical finding. One thing I have found clinically is that it’s important to re-assure the patient that the discomfort they feel from the isometric contraction is okay and is safe. Sometimes there’s a delay in the pain reduction.

6. This doesn’t really fit what I see clinically. “Subjects with LBP displayed less lower lumbar extension than control subjects during prone extension. These differences should be considered when evaluating and prescribing prone extension” Maybe the take-home point is that people with LBP have poor motor control and a loss of segmental spinal dissociation that leads to decreased extension? Maybe it’s high-threshold strategies or guarding against a perceived threat? Or maybe like the study says, it’s just less motion and poor movement. Regardless, quadruped cat-camel seems like a safer way to assess this rather than forcing end-range in a painful patient.

7. Christine Ruffolo goes over ankle plantarflexion from an isolated joint ability (CARs) to a full functional use. Worth the read. I really like the idea of using an unloaded knee flexion to add some degrees of freedom to the system.

This is a collection of information to help improve health and movement. It includes articles, videos, and quotes that I have found helpful in studying the human species. Due to the complexity of this subject matter, I have tried to include a variety of variables that can influence the dynamic system.

In an attempt to avoid information overload, I’ve separated the information into different categories.

I will post each category separately to make it easier to scroll through.

The links below will be added over the next month as they are posted.

Feel free to follow me on social media to keep up to date on the latest postings.

Making this information accessible for everyone takes a great deal of effort and time. If you have the resources, please consider a donation. Your support to maintain this website is greatly appreciated.

The Hits

This is a collection of some of my favorite articles from the past month. I bolded and underlined the numbers of the articles that I found most remarkable. Of course, this is just my bias. I think all the articles here have value. I realize that some readers may be looking for something more brief.

Unfortunately, I am currently busy with a couple other projects and do not have the resources to produce a collection of “Hits” every month. However, I’ll continue to do my best to get it out as frequently as I can.

For a more real-time update of movement and health information follow me on social media:

If you enjoy this collection and find it valuable, please share it with other professionals. If you have the resources available, please make a donation to help me run this site and continue to put information out there to help movement professionals grow.

Also, I want to encourage any readers to share their favorite articles, books, or podcasts of the month in the comments below. I know there’s a ton of great stuff out there that isn’t on my radar. It will introduce me and other readers to new perspectives.

Clinical

“You can recognize a deep truth by the feature that it’s opposite is also a deep truth” – Frank Wilczek

1) “The human body is one of the most complex organizations of matter in the known universe. To understand it, we must build models, use metaphors, and deal in abstractions. This necessarily involves ignoring certain details, creating simplified pictures, and relying on metaphors that have the potential to mislead. But we have no choice! Models and metaphors are indispensable thinking tools to understanding the body. Each model is a different perspective from which to see the world, with its own unique insights and blindspots.” –Todd Hargrove

2) Michael Mullin shares his highlights and thoughts from a great article on the diaphragm.

3)Solid article from Chris Beardsley – “Eccentric training produces specific gains in eccentric strength, partly by increasing the strength of the passive elements in a muscle, which makes them stiffer. This gives muscles a greater capacity to decelerate, and absorb energy. This superior ability to absorb energy is probably why eccentric training then leads to a reduction in the risk of getting a muscle strain injury.”

The Hits

This is just a collection of some of my favorite articles from the past month. I bolded the numbers of the articles that I found most remarkable. Of course, this is just my bias. I think all the articles here have value. I just realize that some readers may be looking for something more brief.

Also, I want to encourage any reader to share their favorite articles, books, or podcasts of the month in the comments below. There’s only so much information that I can go through in a month. I know there’s a ton of great stuff out there that isn’t on my radar. It will not only help introduce me to new perspectives, but it will provide other readers this opportunity as well.

Epistemological Arrogance

1) “Epistemic Arrogance: measure the difference between what someone actually knows and how much he thinks he knows. An excess will imply arrogance, a deficit in humility. An epistemocrat is someone of epistemic humility, who holds his own knowledge in greatest suspicion.” -Nassim Nicholas Taleb

2)Complex does not mean complicated – “Complicated systems are usually built from design, and include cars, computers and buildings. Complex systems were not built but evolved, and include living things, ecologies and economic systems.” Great piece by Todd Hargrove

3) Sometimes in the buffet style of information digestion that is the internet, there will be “gurus” out there who will claim “all health problems can be fixed with these “3 things you’re not doing”. Or worse, they’ll take a “if your not doing ___ you’re missing the boat” approach.

Those of us in clinical practice know it’s not this simple. The problem is that ranting about a simple, secret solution to a complex problem gives people either false hope or it makes them feel bad as a clinician that they don’t know about the “secret answer”. And I don’t think anyone in healthcare should be making clinicians feel bad or teaching through narcissistic ways.

“For every complex problem there is an answer that is clear, simple, and wrong” -H.L. Menken

Keeping “it” simple is important at times. It prevents us from becoming overwhelmed, clarifies concepts, aids in general understanding, and directs the focus towards a single goal. Most importantly, keeping it simple is necessary when communicating new topics or concepts to others. However, the problem occurs when keeping it simple is used a substitute for understanding the complexity.Continue reading “Embracing Complexity: The Mountain Stream Metaphor”

The Hits

This is just a collection of some of my favorite articles from the past month. I bolded the numbers of the articles that I found most remarkable. Of course, this is just my bias. I think all the articles here have value. I just realize that some readers may be looking for something more brief.

Also, I want to encourage any reader to share their favorite articles, books, or podcasts of the month in the comments below. There’s only so much information that I can go through in a month. I know there’s a ton of great stuff out there that isn’t on my radar. It will not only help introduce me to new perspectives, but it will provide other readers this opportunity as well.

Phone Addiction

“Only one thing made him happy and now that it was gone everything made him happy.” -Leonard Cohen

A big part of our ability to live longer comes from the knowledge of what harms us. Smoking, aluminum production, lead, high fructose corn syrup, artificial sweeteners, poor sleep, sitting, and now smartphones.

Unfortunately, not many people are open to the idea that their cell phones are bad for them. At least not beyond a surface level acknowledgement.

I wrote this article on 25 reasons why your cell phone is bad for you. It has a ton of resources for many different categories. Hopefully it will serve as a resource to bring awareness of the hazards of smartphone overuse. Share it with those that you think need to hear it.

Before I proceed and alienate everyone, I first want to clarify that I am not against technology and I don’t think smartphones are inherently bad. I’m not trying to pull a John Connor and convince you to rage against the machine and destroy your cell phone.

In fact, I think technology is a critical component of our culture’s development. Smartphones can be extremely helpful. Not only can they end many arguments with instant fact-checking, but they provide an endless supply of free information and the ability to connect with almost anyone in a first world country. This creates many opportunities that wouldn’t exist otherwise.

But like my mom always says, “everything is okay…in moderation.”

The problem arises when smartphones go from a tool to a behavior. Soon after this, addiction ensues. Next thing you know you’re so dependent on your cell phone that you’re looking for outlets in public places.Continue reading “The Problem with Smartphones”

The Hits

This is just a collection of some of my favorite articles from the past month. The bolded the numbers of the articles that I found most remarkable. Of course, this is just my bias. I think all the articles here have value. However, I realize that some readers may be looking for something more brief.

Also, I want to encourage any reader to share their favorite articles, books, or podcasts of the month in the comments below. There’s only so much information that I can go through in a month. I know there’s a ton of great stuff out there that isn’t on my radar. It will not only help introduce me to new perspectives, but it will provide other readers this opportunity as well.

Clinical

“The job of a skilled therapist is to detect where the system is open to change, to provide the appropriate new input to destabilize the old pattern, and to facilitate the person’s seeking of new solutions” -Esther Thelen (via Seth Oberst)

1) One of the better ACL articles I’ve read in a while. Read this post – especially the part on terminal knee flexion. Great explanations and quick video demonstrations. Very useful for the clinic tomorrow. Here’s one gem from the article series – “The ability of the hamstring to pull the heel to butt is a necessary pre-requisite for dorsiflexion.”

2) The Longus Capitus attaches to the foramen magnum? How did I overlook that?

3) Sick of patients asking for you to put their pelvis/SIJ back in place? Try these 3 steps to change their thought virus.

News

As you may or may not have read in a previous article, I’m leaving NYC and moving to Asheville, NC. My girlfriend and I have decided to take advantage of this transition and are taking a small “sabbatical”. Part of this time off involves a selfish 3 week trip to New Zealand this month. Unfortunately, this means I won’t be able to get a “January Hits” post out this month. I do have posts scheduled on my Facebook account, but other than that you guys are on your own!Continue reading “The Best of 2015”

News

Unfortunately, my time in NYC is coming to an end. I’ve spent over 8 years here and I’ve enjoyed the buzz, the people, the music, and the late night slices . However, I’m ready for a lower cost of living, a little less concrete, a little more nature, and a slower pace. So I’m moving to Asheville, North Carolina in January.

I wrote this article on 5 things I’ve learned from my mentorship at Dynamic Sports Physical Therapy. I feel that one thing missing from the movement social media world is a discussion on the things that happen “behind the scenes” that make the difference between a good clinician and a great one. While evidence, trendy semantics, cool neuro language, the latest performance enhancement, and arguments over what someone else is doing can be fun to read, they don’t always translate to improving clinical performance.

If there’s anything I’ve learned from my 5 years as a PT in NYC, it’s that there’s a lot more to treating patients than what you can read in a journal, book, or blog. Hopefully the article above will help explain this concept (yes, I know it’s a blog and I’ve just contradicted myself, but if you read it you’ll get the point).Continue reading “December Hits (2015)”

I was very lucky to be mentored by Chris Johnson after PT school. I observed and worked part-time in his clinic for almost a year. I learned a tremendous amount from him and was excited to get an update on his approach during his Treadmill Analysis Workshop this past Wednesday.

Chris is the premier running expert. He doesn’t practice what he preaches, he’s a master of it (2x Kona Qualifier). He dives deep into research to stay current on the latest evidence and to improve care. And most importantly, he spends a ton of time treating and training endurance athletes.

The minimal effective dose rule goes into effect here. You want to achieve the necessary movement change with the minimal amount of sensory change. If you throw too many different cues (verbal, visual, proprioceptive) at the same time, it will clog up the system and wear down the patient. As mentioned in the previous articles, it comes down to attention economy – you always want the movement to have the spotlight, not the cues. Continue reading “Coaching & Cueing (Part 7 – Phases & Summary)”

Clinical

“Each time we introduce an assumption, we also introduce a new bias into the final solution” -Serge Gracovetsky

1) “Our neurological wiring has evolved into networks of patterned behavior designed to efficiently complete tasks mandated by the environment. Anatomy provides the frame to carry out these behaviors; the changes to structure are the tangible result of our habits. But once we open up some behavioral options for new habit formation, anatomical abnormalities don’t seem quite so concrete and problematic.”-Seth Oberst

This is a very common intervention in movement coaching (whether the practitioner knows it or not). Simply changing an exercise to achieve the same goal is essentially a proprioceptive cue. Changing from a clamshell to a fire-hydrant can be a proprioceptive cue by altering the ascending sensory information during an isolated transverse plane glute strengthening exercise.Continue reading “Coaching & Cueing (Part 6 – Proprioceptive Cues)”

Clinical

1) Dan Pope shares another awesome video exercise progression – this time it’s on jump variations. He literally shows you how to bridge the gap in this one. Great stuff.

2) Leon Chaitow goes over pulsed muscle energy technique. A much safer and more effective intervention than cranking on joints with aggressive stretching. Take note of his communication in the video – calm, slow, speaking – external cues – takes his time to get the patient to perform exactly what he wants. #Variables

3) Tom Goom writes some of the best running articles out there. Here’s a great post on the importance of load capacity, the envelope of function, kinetic chain load, and the non-tissue issues. This might be the most important concept in rehab.Continue reading “September Hits (2015)”

Clinical

1) Read this one – the most detailed and thorough blog post on movement variability. Great stuff from Dave Tilley.

“With movement practice, it is believed by some that coordinative variability decreases (better able to synergies motor patterns for general movement planning) while elemental variability increases (more strategies to generate real time adjustments or handle different conditions while still successfully completing the given task or skill).”Continue reading “August Hits (2015)”

Unfortunately, the rise in popularity of external cueing has led to a bad stigma of internal cueing. After reading the last article in this series you may be thinking why would you ever internally cue someone?

2) Do you know when to use an External Cue? Do you know why? If not, here’s the answers – External Verbal Cues.

3) The Gait Guys teach you about Forefoot Supinatus – “A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous where a forefoot supinatus is acquired and develops because of subtalar joint pronation.” Continue reading “July Hits (2015)”

Clinical

1) Sure, it’s a dynamic system and the nervous system has a huge influence. But you can’t dissociate the physicality of our world from the human body. Simple biomechanics can have a profound effect on your patient’s movement. Here’s an example of how the first class lever works to Increase Glute Med Activity.

2) Don’t forget about the frontal plane aspect of the bunion deformity – “the degree of first metatarsal pronation is linearly related to the amount of medial deviation of the first metatarsal”

3) Kathy Dooley goes over the Obturator Externus – “When this muscle is locked long, it will contribute to hip compression. Since the muscle travels from the anterior outer pelvis posteriorly to the greater trochanter’s inner fossa, it works as a sling with obturator internus to keep that femur jammed into the acetabulum. “ Continue reading “June Hits (2015)”

My co-worker was on vacation recently and I was seeing one of his chronic pain patients (years of pain). She was doing very well and was becoming independent in a full exercise routine. I did a quick evaluation and noticed one thing that she could improve on from a movement perspective. I didn’t use any dangerous pathoanatomical language. I just simply pointed out that she could be stronger if she kept her rib cage down when she performed certain exercises. We went over this cue a bit more with some basic proprioceptive exercises before she started her exercise program. Continue reading “Coaching & Cueing (Part 1 – Intro)”

Clinical

1) I often have athletes come into the clinic that have been aggressively stretching their hips or shoulders. They keep getting tight, keep stretching, and keep getting injured. I have found that the culprit for these injuries is usually not a mobility problem. Instead, it is often the result of a poorly tied knot.

2) Mike Cantrell teaches you about rib cage dynamics in these 2 videos (1, 2). Great stuff for anyone that enjoys learning about anatomy, biomechanics, and movement.

Clinical

1) Lately, I’ve been interested in the connection between vision and the cervical spine. Here’s two interesting articles I found this month.

“The direction of eye movements was horizontal when the sternocleidomastoidmuscle on one side of the neck and the splenius on the other side were activated, and downward when both splenii muscles were vibrated.”

“During neck rotation SCM and MF EMG was less when the eyes were maintained with a constant intra-orbit position that was opposite to the direction of rotation compared to trials in which the eyes were maintained in the same direction as the head movement.”

I put people in challenging developmental positions and have them use their vision to either increase motion or to dissociate their vision from their cervical spine (changing muscle activation patterns).

Clinical

1) There’s a weird campaign by some Hipster PTs who are arguing that posture isn’t important. Maybe they’re doing it for social media popularity. Maybe what they’re really trying to say is that we shouldn’t create thought viruses. Maybe what they’re saying is that we shouldn’t blame all of our patients’ problems on a static postural assessment. Maybe they don’t understand that posture is a biobehavioral pattern. Regardless of their underlying point, dogmatically saying posture doesn’t matter is like saying physics and physiology doesn’t matter.

2) “From a sensory perspective, moving fast has a lot of sensory noise – it’s loud…By lowering the magnitude of the sensory stimuli, we can better perceive excessive muscular rigidity and help to regulate it.” – Seth Oberst

3) “The 90-90 hip lift says that the pelvis is too far forward, especially on the left and we would like to put it back to a neutral position and we are going to use a couple muscles to keep it there” –The Nominalist

Clinical

1) I first learned about the relationship between the pelvis and hip ROM from Chris Johnson – you can instantly increase hip IR on the table by having the patient posterior pelvic tilt. Then upon studying the concepts of SFMA, DNS, and PRI, I began to understand how the pelvis (as well as diaphragm/thorax/spine) influences the hips. Now I understand that most hip impingement patients are really pelvis patients, not femur patients. Mike Reinold wrote a concise and simple post on this concept here.

I was lucky enough to be invited to another one of Dan Park’s quality continuing education classes at Perfect Stride. This time it was for Functional Range Release (Upper Extremity) with Andreo Spina. I had been reading a lot about Spina’s work and was excited at the chance to learn about the FR/FRC techniques and principles. Continue reading “Andreo Spina’s Functional Range Release”

1) If you are a manual therapist, please understand the current concepts of manual therapy. One of these concepts is that we cannot cause an immediate and permanent plastic deformation of tissues. So painfully digging into tissues to “release” them is really just another form of torture. Here are 3 Pain Free Manual Techniques from Erson – Pec Minor, Psoas, QL.

2) “Based on animal studies, it has been proposed that central sensitization associated to nociception (maladaptive plasticity) and plasticity related to the sensorimotor learning (adaptive plasticity) share similar neural mechanisms and compete with each other.”

One of the best things about the information age is the amount of great content out there. There are so many smart, generous individuals sharing information that can improve your skills and increase your quality of care. These blogs are accessible, straight forward, and clinically applicable. Here is my year end summary of some of my favorite stuff from this past year.

I came out of the stone-age and started using Google Analytics, which allowed me to see which of my articles were most popular, and which ones were only read by my girlfriend. It wasn’t what I expected.

Keep in mind that these lists are in no particular order. And also, this is just a small amount of the great articles out there. It’s just the ones I enjoyed the most from a years worth of Hits. If your favorites weren’t listed here, please feel free to leave a comment with your Top Reads. Continue reading “The Best of 2014”

1) Two great articles on placebos. The evolutionary history of placebos from Nicholas Humphrey – “when people are cured by placebo medicine, they are in reality curing themselves” – “The placebo effect is a particular kind of priming effect.” And how placebo helps pain from Todd Hargrove – “In other words, the placebo effect does not involve anything magical. It is one of many ways that our cognition affect our physiology.” – “The research of Benedetti and others has identified three different patterns of mental processes that create the placebo effect: (1) expectations of benefit; (2) reduction of anxiety; and (3) learning through association.” Continue reading “December Hits (2014)”

1) Stress is stress. And there are many outputs that can occur in response to stress. Too often we get stuck obsessing over just one of the outputs – PAIN. As movement professionals we should focus on the output that we’re the most proficient at – MOVEMENT. If you disagree, Zac Cupples will convince you in this phenomenal article. “Assessing movement may be the simplest way to assess an individual’s stress status.”

3) “If your tongue is on the roof of your mouth, you are connecting palate, pharynx, hyoid, jaw, and skull. You are stabilizing your airway, so you can breathe, while anchoring your TMJ so it doesn’t deviate. Now, your body is more balanced and can better ambulate.” –Kathy DooleyContinue reading “November Hits (2014)”

As many physical therapists have probably noticed, there is an increase in the amount of Crossfit athletes showing up in our clinics. This isn’t because it injures everyone. It’s because it’s becoming very popular and people love it.

We see the same thing happen during ski season and marathon season. It’s not necessarily the activity, it’s the increase in participation.

However, that’s not to say that it’s only an increase in participation that leads to a higher incidence of injuries. There are many other variables involved. Some of which can be improved upon to decrease the risk of injury.

1)A good soap box by Roger Kerry – “Calls to abandon a biomedical model is evidence-based moronicy. And downright dangerous.” – “Movement is everything.” – “Movement helps people contribute to society and it keeps the world going.” – “If you are a research funder, PLEASE STOP FUNDING RIDICULOUS RCTs.”

1) “Maintaining the short foot position can generate an arch and produce a monstrous feed-forward loop that maintains tension and stability throughout the system reinforcing to the brain that force can be safely produced. When the arch collapses the nervous system quickly downregulates in an attempt to avoid excess force thru the entire lower quarter while in an unstable position, yielding decreased output.” -Seth Oberst on foot positioning

2) Tendinopathy research goes pretty deep. There has been a lot of progress over the years, but there is still a ton we don’t know. Here are 2 posts to update your knowledge: 1) Peter Malliaras’s tendinopathy research post 2) 10 Clinical Pearls from ISTS 2014

On August 2 and 3rd I was lucky enough to part take in Mark Cheng’s Prehab-Rehab 101 workshop at Perfect Stride in NYC. This was not only a special event because of the instructor and content, but it was the smallest class size I’ve ever been in. There were only 13 other clinicians in the class. Having this much of Mark’s attention provided for a great learning experience. Continue reading “Mark Cheng Prehab-Rehab 101 Workshop Review”

Two of my favorite things to do in my practice are to assess movement patterns and use kettlebells. So when I heard about the amalgamation of FMS and StrongFirst I was pretty stoked. Throw on top that Gray Cook and Brett Jones were teaching the course, and it was my most anticipated course of all time. Continue reading “Foundational Strength Course Review”

1) “When an imparted load exceeds the load bearing capacity of the tissue accepting it, damage occurs. Neurological errors in movement execution commonly lead to loads being placed on “unprepared” tissues. It is therefore important to focus on two aspects of training to reduce the likelihood of sustaining injuries: 1. Working on improving neural control via progressively complex movement tasks – 2.Improve the physical, mechanical load bearing capacity of tissues.” – Andreo Spina

1) Do you know about the anti-icing movement? Many are advocating against cryotherapy post injury. Some blindly jump on the bandwagon, some feel threatened and become defensive, and most of us just want to know why. I’ve recently come across a couple great articles on the theory and evidence that explains why we should not ice injuries. Even if you continue to ice, you should at least know what it really does (e.g. numbing effect, descending modulation, body temp regulation, placebo). Continue reading “May Hits (2014)”

I am a big fan of the FMS (Functional Movement Screen) and SFMA (Selective Functional Movement Assessment). Together these screens and their associated principles make up the Functional Movement Systems.

I’ve been using this system for a couple years and have had a lot of success with it. The more efficient I become at this approach, the more my outcomes improve.

Part I went over stress, tissues, the nervous system, and many of the factors that are involved with recovery.

Throughout a PT session there are many opportunities to influence the patient’s health; both for the immediate and long term effects. This post will go over the 4 factors of recovery that I often try to discuss with patients before they are discharged from Physical Therapy. Continue reading “The Art of Recovery (Part 2 of 2)”

1) Communication is just as important as the intervention. Seth Oberst writes a great post on the difference between external and internal cues. “It’s now being shown that athletes focusing on the results of the movement are producing more force, jumping higher, generating better performance in stressful situations, and increasing fluidity and multi-tasking.”

2) Evolution has shown us the importance of diet and the jaw on our growth as a species. Here’s an interesting site on the jaw and it’s relation to the co-morbidities.

One of the most difficult questions to answer in rehab is: “when will I get better?”

Coming out of grad school my response was usually mumbling some ridiculous time period with a deer in the headlights look on my face. I had no idea. I knew the tissue healing timetable…and that was about it. I had little experience with specific injuries and didn’t yet understand the complex, multi-faceted factors that influence recovery.

1) One of the best things about PRI is their interdisciplinary approach. They’ve done a great job at providing holistic care. Specifically, PRI Vision is putting out some great stuff. PT’s have been stuck advising the same ergonomics with the same reasoning for the past 30 years. Heidi Wise goes over a more methodical way to address your patient’s ergonomics (Part 1 & Part 2).

2) Kevin Carr goes over some great Row Progressions. Use these for your patient. Use these for yourself in the gym.

In the past 10-20 years there has been a trend towards stabilizing the proximal joint. Everything seems to be going more and more proximally. And this is a good thing! It is providing us with better outcomes and quicker pain free rehabilitation.

If you look at the knee joint you can see the progress. We’ve gone from isolated patella mobs and VMO strengthening to hip strengthening. And now we are going even further up the chain and looking at lumbo-pelvic complex.

The same thing is happening with the shoulder. We’ve gone from isolated thera band ER/IR to scapula stabiliztion. And now we are going even further and looking at the thoracic spine and ribs.

1) Pain and Central Sensitization is a growing topic in our field. And for a good reason, pain is the #1 reason people come to see us. Plus, chronic pain is becoming more and more common. It’s great having so much information available to learn about these topics, however, there isn’t a lot of information on the specific clinical application. I sought out pain expert, Adriaan Louw, to answer some clinical questions on pain science in this months post.

Adriaan Louw is a busy man. Between running ISPI (International Spine & Pain Institute), performing research, treating patients, drinking beer, and watching football he doesn’t have a lot of free time. However, he was kind enough to answer some quick questions to help me understand pain, central sensitization, and the clinical application of neuroscience. As always, his answers were very helpful and I thought I’d share them with everyone else. Continue reading “11 Questions with Adriaan Louw”

1) Human movement isn’t always as simple as basic kinesiology and anatomy. James Speck gives a great example of this in his detailed article describing the soleus as a knee extender. “When a muscle contracts, it doesn’t think about which direction in needs to pull. It just shortens.”

2) More on pain science: “…they used newer MRI technology to see how flexible people could be in responding to pain. The mind-wanderers were more flexible.” Pain isn’t a pathological structure; it’s a central processed perception.

3) I recently had a medial elbow tendinosis patient. When I screened him with the SFMA his single leg balance was terrible. He had some severe ankle/foot stability deficits. This study was in a recent JOSPT. Regional interdependence. SFMA. Continue reading “December Hits (2013)”

I have been following Erson Religioso, a PT and blogger, for quite some time now. He has repeatedly (no pun intended) discussed the effectiveness of Mechanical Diagnosis & Therapy (The McKenzie Method or MDT). He’s a very knowledgable clinician and runs his social media with integrity. Over the years he has provided a great deal of clinically applicable information and I have seen results in my practice using some of his methods.